Understanding the home as a source of infection of AMR bacteria carried by dust by exploring hygiene practices in different home environments in Ghana
Lead Research Organisation:
Lancaster University
Department Name: Lancaster Inst for the Contemporary Arts
Abstract
The Dust Bunny project will apply design methods coupled with microbiological analyses to address issues of home-based infections in Ghana, particularly those carrying antimicrobial resistance, resulting in a reduction of infection and in positive increase of health outcomes.
Bacteria found in the natural and built environment (e.g. homes, schools, hospitals, etc.) are building up a resistance to drugs -changing to protect themselves against antibiotics. What this means is that in the not-too-distant future, something as simple as a minor cut infection could become life-threatening. This is such a concern that antimicrobial resistance (AMR) is now considered a global health crisis, far surpassing outbreaks of diseases such as Ebola and as real as climate change. This is even more evident and critical in developing countries in Africa, such as in Ghana, where there are a great number of deaths from infectious diseases.
Bacteria are made up of pathogens (bad germs) and non-pathogens (good germs) and are generally scattered across the home. Most surfaces in the home are covered to a certain degree with bacteria, but unlike fixed surfaces such as kitchen work surfaces and furniture, dust can move more easily around different parts of the home and therefore presents a major route for human exposure to bacterial infections.
Despite being clear evidence for microbial exposure and infection transmission within the home, there has been less research effort invested in understanding the home environment, due to difficulty of conducting detailed studies. Although the transmission routes by dust in the home environment are well known, what has not been studied is how to prevent bacterial infection at home and thereby reduce resistance.
Particularly in developing countries, such as Ghana, social inequalities mean a range of different quality and types of homes; this combined with often poor levels of domestic hygiene that is influenced by a number of economic, educational and religion factors, contributes to the spread of infectious diseases.
Although there are hygiene guidelines available for preventing infection in the home environment, these are targeted at hygiene professionals and do not reach the everyday household in Ghana. There is therefore a much-required and unmet need to identify, understand and develop domestic hygiene practices that are relevant to different home environments, educational and cultural backgrounds in developing countries, such as in Ghana, in order to reduce exposure to bacteria pathogens and thereby exposure to resistance forms.
Within this context, the Dust Bunny project aims at developing an understanding of the home as a source of infection of bacteria, resistant to antibiotics, found and carried by dust. This will be done by exploring hygiene practices across different home environments in Ghana, with the ultimate aim to reduce bacterial infection in the home environment thereby reducing AMR.
Understanding the hygiene practices in the household and interactions with airborne AMR bacteria will serve as a first step to designing appropriate education/information dissemination materials for various sections of the Ghanaian population as well as other low- and middle-income countries in Africa.
Dust Bunny, uniquely combines design research and microbiology to provide an informed assessment of societal practices in domestic cleanliness and novel solution to reduce infections in the home. The project team includes Imagination@Lancaster -an internationally leading research institution in design research- and the Noguchi Memorial Institute for Medical Research -a research centre of excellence and the prime biomedical research institution in Ghana, involved with the Ghana Health Service and Ministry of Health in providing the evidence to effect policy changes.
Bacteria found in the natural and built environment (e.g. homes, schools, hospitals, etc.) are building up a resistance to drugs -changing to protect themselves against antibiotics. What this means is that in the not-too-distant future, something as simple as a minor cut infection could become life-threatening. This is such a concern that antimicrobial resistance (AMR) is now considered a global health crisis, far surpassing outbreaks of diseases such as Ebola and as real as climate change. This is even more evident and critical in developing countries in Africa, such as in Ghana, where there are a great number of deaths from infectious diseases.
Bacteria are made up of pathogens (bad germs) and non-pathogens (good germs) and are generally scattered across the home. Most surfaces in the home are covered to a certain degree with bacteria, but unlike fixed surfaces such as kitchen work surfaces and furniture, dust can move more easily around different parts of the home and therefore presents a major route for human exposure to bacterial infections.
Despite being clear evidence for microbial exposure and infection transmission within the home, there has been less research effort invested in understanding the home environment, due to difficulty of conducting detailed studies. Although the transmission routes by dust in the home environment are well known, what has not been studied is how to prevent bacterial infection at home and thereby reduce resistance.
Particularly in developing countries, such as Ghana, social inequalities mean a range of different quality and types of homes; this combined with often poor levels of domestic hygiene that is influenced by a number of economic, educational and religion factors, contributes to the spread of infectious diseases.
Although there are hygiene guidelines available for preventing infection in the home environment, these are targeted at hygiene professionals and do not reach the everyday household in Ghana. There is therefore a much-required and unmet need to identify, understand and develop domestic hygiene practices that are relevant to different home environments, educational and cultural backgrounds in developing countries, such as in Ghana, in order to reduce exposure to bacteria pathogens and thereby exposure to resistance forms.
Within this context, the Dust Bunny project aims at developing an understanding of the home as a source of infection of bacteria, resistant to antibiotics, found and carried by dust. This will be done by exploring hygiene practices across different home environments in Ghana, with the ultimate aim to reduce bacterial infection in the home environment thereby reducing AMR.
Understanding the hygiene practices in the household and interactions with airborne AMR bacteria will serve as a first step to designing appropriate education/information dissemination materials for various sections of the Ghanaian population as well as other low- and middle-income countries in Africa.
Dust Bunny, uniquely combines design research and microbiology to provide an informed assessment of societal practices in domestic cleanliness and novel solution to reduce infections in the home. The project team includes Imagination@Lancaster -an internationally leading research institution in design research- and the Noguchi Memorial Institute for Medical Research -a research centre of excellence and the prime biomedical research institution in Ghana, involved with the Ghana Health Service and Ministry of Health in providing the evidence to effect policy changes.
Planned Impact
Building on the 4 identified impacts in our Pathways to Impact document, here we expand on who we envisage benefiting from this research and develop further how they would benefit:
[IO1] Disseminating the findings: to academic and non-academic audiences in the UK and Ghana. Mechanisms, such as the project website, social media, regular dissemination trough the AHRC, ESRC AMR Champions and NERC AMR Programme Leader, academic (conference & journal papers) and non-academic publications (press releases/media briefings & newsletters via our partners, the Design Council, EPN/ReAct Africa, Zoomlion, Global Hygiene Council) will help in achieving this.
[IO2] Raising the profile: to engage appropriate stakeholders thereby bringing the research to the attention of a wider audience and solicit feedback as research insights emerge. Through our collaborators we will engage government and health policy makers who are actively involved in healthcare and AMR reduction such as the Ghanaian government, World health Organisation and United Nations Development programme. By engaging our governmental and non-governmental partners, the outcomes of this study will help to further inform Ghana's national antimicrobial resistance policy; and will further help inform future policy interventions to change the daily routine of hygiene practice to reduce bacterial pathogens and thereby exposure to antibiotic resistant forms which complicate and prevent effective treatment of diseases. Mechanisms for this include our advisory panel and project partners, co-design workshops with communities and expects in Ghana; a thought leaders workshop and development of personas of hygiene practices across different user groups.
[IO3] Engaging and co-developing: with the aim of ensuring shared ownership of the action plan, the research insights will be co-developed through engagement with key stakeholders and beneficiaries including discussions with key influencers at regional and national levels. We will engage wider society/community, usually via a relatively small group of change makers within communities, to inform and be informed by research, and so to co-design and implement the 'smart solutions' that are appropriate to the domestic environment on a range of social scales. To this end, the project will feed information and possible changes to Ghana's government-driven goal of reducing antimicrobial resistance, which uses the React toolbox incorporating into React Ghana's (one of our project partners) national AMR policy through its national AMR policy. Mechanisms for achieving this includes community engagement in Ghana through seminars, workshops, flyers in schools, churches, mosques and other relevant community access points; development of storyboards & other dis/nation material of co-designed hygiene practices; follow-on GCRF bid scoping workshop in Ghana.
[IO4] Capacity building and Knowledge Exchange: on hygiene practices, design-based and AMR based research in low and middle income countries in the African continent, such as in Ghana (for UK and Ghanaian researchers). Building capacity to deliver strategic development goals (3: Good health and well-being; 11: Sustainable cities and communities) from research in science & technology, which here encompasses microbiology and design, requires more than just research and training in those disciplines. It also demands research and training in the social and management sciences that maximises the capacity for translation to life influencing design in wider communities to shape the design, development and exploitation of this project. Our strategy is to build capacity and capability is fundamentally interdisciplinary. Mechanisms for this include our project partners (Design Council, EPN/ReAct Africa, Zoomlion, Global Hygiene Council), research exchange and training of the UK & Ghanaian researchers of the project and capacity building and knowledge exchange workshops to be held in the UK & Ghana.
[IO1] Disseminating the findings: to academic and non-academic audiences in the UK and Ghana. Mechanisms, such as the project website, social media, regular dissemination trough the AHRC, ESRC AMR Champions and NERC AMR Programme Leader, academic (conference & journal papers) and non-academic publications (press releases/media briefings & newsletters via our partners, the Design Council, EPN/ReAct Africa, Zoomlion, Global Hygiene Council) will help in achieving this.
[IO2] Raising the profile: to engage appropriate stakeholders thereby bringing the research to the attention of a wider audience and solicit feedback as research insights emerge. Through our collaborators we will engage government and health policy makers who are actively involved in healthcare and AMR reduction such as the Ghanaian government, World health Organisation and United Nations Development programme. By engaging our governmental and non-governmental partners, the outcomes of this study will help to further inform Ghana's national antimicrobial resistance policy; and will further help inform future policy interventions to change the daily routine of hygiene practice to reduce bacterial pathogens and thereby exposure to antibiotic resistant forms which complicate and prevent effective treatment of diseases. Mechanisms for this include our advisory panel and project partners, co-design workshops with communities and expects in Ghana; a thought leaders workshop and development of personas of hygiene practices across different user groups.
[IO3] Engaging and co-developing: with the aim of ensuring shared ownership of the action plan, the research insights will be co-developed through engagement with key stakeholders and beneficiaries including discussions with key influencers at regional and national levels. We will engage wider society/community, usually via a relatively small group of change makers within communities, to inform and be informed by research, and so to co-design and implement the 'smart solutions' that are appropriate to the domestic environment on a range of social scales. To this end, the project will feed information and possible changes to Ghana's government-driven goal of reducing antimicrobial resistance, which uses the React toolbox incorporating into React Ghana's (one of our project partners) national AMR policy through its national AMR policy. Mechanisms for achieving this includes community engagement in Ghana through seminars, workshops, flyers in schools, churches, mosques and other relevant community access points; development of storyboards & other dis/nation material of co-designed hygiene practices; follow-on GCRF bid scoping workshop in Ghana.
[IO4] Capacity building and Knowledge Exchange: on hygiene practices, design-based and AMR based research in low and middle income countries in the African continent, such as in Ghana (for UK and Ghanaian researchers). Building capacity to deliver strategic development goals (3: Good health and well-being; 11: Sustainable cities and communities) from research in science & technology, which here encompasses microbiology and design, requires more than just research and training in those disciplines. It also demands research and training in the social and management sciences that maximises the capacity for translation to life influencing design in wider communities to shape the design, development and exploitation of this project. Our strategy is to build capacity and capability is fundamentally interdisciplinary. Mechanisms for this include our project partners (Design Council, EPN/ReAct Africa, Zoomlion, Global Hygiene Council), research exchange and training of the UK & Ghanaian researchers of the project and capacity building and knowledge exchange workshops to be held in the UK & Ghana.
Organisations
- Lancaster University (Lead Research Organisation)
- Medical Research Council (Co-funder)
- Women's Economic Imperative (Collaboration)
- HERD International (Collaboration)
- Noguchi Memorial Institute for Medical Research (NMRR) (Collaboration)
- UNIVERSITY OF LEEDS (Collaboration)
- Lancaster University Ghana (Project Partner)
- Design Council (Project Partner)
Publications
Cooper R
(2018)
ImaginationLancaster: Open-Ended, Anti-Disciplinary, Diverse
in She Ji: The Journal of Design, Economics, and Innovation
Darby A
(2021)
Design for Global Challenges and Goals
Ghani F
(2020)
Handbook of Global Health
Mitchell J
(2019)
The values and principles underpinning community engagement approaches to tackling antimicrobial resistance (AMR).
in Global health action
Mitchell J
(2022)
Community engagement: The key to tackling Antimicrobial Resistance (AMR) across a One Health context?
in Global public health
Tsekleves E
(2021)
Design for Global Challenges and Goals
Tsekleves E
(2023)
Developing home cleaning intervention through community engagement to reduce infections and antimicrobial resistance in Ghanaian homes
in Scientific Reports
| Description | The Dust Bunny project seeks to develop an understanding of the home as a source of infection of AMR bacteria carried by dust, by exploring hygiene practices across different home environments in Ghana, with the ultimate aim to reduce bacterial infection in the home environment thereby reducing AMR. The design ethnography was intended to give researchers a closer understanding of the cleaning practices and the perceptions of cleanliness and hygiene, in relation to dust, of householders and the people who regularly clean homes as part of, and for, households in the Greater Accra Region of Ghana. In addition, it sought to gain insights into the physical actions undertaken and the range of cleaning agents and cleaning tools used as part of those actions. To examine the domestic microbiome and its antimicrobial resistance carrying capacity household dust samples were taken from the same volunteer households (n=12) for analysis. We tested the bacteria for resistance to a number of commonly used antibiotics and found that about 35% of those tested carried resistance to at least one antibiotic and some carried resistance to more than one. Some of antibiotic resistant bacteria were identified and no were found to be disease-causing but the majority were opportunist pathogens and could cause disease in people who were already suffering from infectious or non-infectious diseases. The most common bacterium found was a non-pathogenic bacterium found in soil but even so it carried a number of resistance which could pass to antibiotic sensitive pathogens making their treatment more difficult. Although the sample size was relatively small it showed us that although the dust was a low risk to health with respect to infectious disease, it provides a pool of antibiotic resistance that could compromise future infections. The process, findings and insights were anonymised and visualised to provide the material for co-designing cleaning practices, that were effective, easy to communicate and specific to the communities in question. Specifically, four scenarios were generated from an economic segmentation of the survey data, 50 ethnographic insights were 'presented' and descriptions of 12 bacteria, that represented the 125 identified species found in the dust samples, were presented to the participants in a codesign workshop. Additionally, a brief introduction to bacteria and AMR was filmed. A codesign workshop (n=7) took place at NMIMR, Accra, Ghana, with LU planning and directing the facilitation and two researchers from NMIMR supporting the delivery of the workshop. Finally, an intervention, a new regime of cleaning practices agreed through the codesign workshop and practiced for thirty days, was made in (n=7) households and another round of microbiological sampling (n=12) and analysis conducted to ascertain any impact on the domestic microbiome. Post-intervention, a second set of 12 dust samples from the same homes, that were either been subjected to an intervention or act as a control by not being subjected to an intervention, were collected. The samples were analysed at a DNA sequence level to reveal the microbial diversity and any differences that occurred as a result of the intervention. The process, findings and insights from all research methods were anonymised and visualised to provide the material for co-designing cleaning practices, that were effective, easy to communicate and specific to the communities in question. Specifically, four scenarios were generated from an economic segmentation of the survey data, 50 ethnographic insights were 'presented' and descriptions of 12 bacteria, that represented the 125 identified species found in the dust samples, were presented to the participants in a co-design workshop. The co-design workshop (n=7) took place at NMIMR, Accra, Ghana, with LU planning and directing the facilitation and two researchers from NMIMR supporting the delivery of the workshop. The workshop assisted participants in drawing together the various strands of the investigation, in order that they might synthesise the findings while co-creating context-specific cleaning practices that could mitigate the impacts of AMR. The contexts, four economically segmented scenarios, were developed from the survey data, and identified different types of dwelling; a single-room compound house, a double-room compound house, a five-room apartment and a ten-room semi-detached house. During the workshop participants had co-created a number of cleaning practices, reviewed them and selected appropriate ones to incorporate into their own cleaning regime and individual cleaning agreements An intervention, a new regime of cleaning practices agreed through the codesign workshop and practiced for thirty days, was made in (n=7) households and another round of microbiological sampling (n=12) and analysis conducted to ascertain any impact on the domestic microbiome. A post-intervention interview was also conducted by going back to the households who participated in the co-design workshop. This coincided with the second round of microbiological sampling. We sought to find out from participants, who took part in the observational study and participated in the co-design workshop, whether the personalised interventions developed influenced their cleaning practices. We discovered that they were influenced by the project in one way or the other as represented in the narratives below. More precisely, we documented new cleaning practices adopted. Most of these practices refer to a) a more structured approach to cleaning in the home; b) increasing the cleaning frequency; c) use of cleaning detergents; and d) use of different cleaning material for different surfaces and rooms. As a result of the projects several community members reported changing their cleaning practices and improving general health. |
| Exploitation Route | These are already been taken forward in a range of conference, journal and other publications. A number of stakeholder workshop events have taken place in Ghana to disseminate the findings and engaging professionals and communities in adopting new ways of cleaning their homes to reduce the introduction and spread of bacteria. An information and education leaflet is currently being developed to address this and will be distributed across 4 districts in greater Accra in April 2020. Two video documentaries have already been independent produced by journalists in Ghana and broadcasted at Ghana TV, the national Ghanaian broadcaster) reaching hundreds of thousands of Ghanaians. An article at The Africa Conversation has also reported on the project and helped disseminate its findings across Africa and Ghana. The lessons learnt from combining interdisciplinary research between design research and microbiology has already been documented and published in open outlets, which will inform new and young researchers who wish to conduct interdisciplinary research. Furthermore a range of tools for data gathering in this area have been made freely available through the project website for researchers and professionals. The cleaning interventions designed and tested as a result of the project are openly available and can be used by NGOs, communities and researchers beyond Ghana. Future research is currently being developed to take the work further. |
| Sectors | Agriculture, Food and Drink,Communities and Social Services/Policy,Environment,Healthcare |
| URL | https://dustbunny.global/ |
| Description | The two video documentaries of the project and its initial findings as well as its information on the importance of cleaning homes to reduce infections, is generating interest in the wider public. the first documentary appeared on Ghana TV (the official broadcaster in Ghana) several times in June/July 2019 and the second in October and November 2019 for more than 15 times and was seen by several thousands of viewers. Following these, our project partners at the Noguchi Memorial Institute for Medical Research at the University of Ghana have been receiving phone call from members of the public who want to find out more about the project and how to protect their households and families from infections through more robust cleaning practices. Several dissemination activities with communities in Ghana took place informing over 150 community members and leaderrs on the impact of clealing for preventing home infections. Community members hav disseminated the project findis within their communities. Also the cleaning education and information leaflet developed as a result of this reserach project was disseminated to hundreds of community members in Ghana. |
| First Year Of Impact | 2021 |
| Sector | Communities and Social Services/Policy,Healthcare |
| Impact Types | Societal |
| Description | AHRC Impact Acceleration Account (IAA) |
| Amount | £450,000 (GBP) |
| Organisation | Arts & Humanities Research Council (AHRC) |
| Sector | Public |
| Country | United Kingdom |
| Start | 03/2023 |
| End | 02/2024 |
| Description | Accelerating the adoption of circular sanitation demonstration systems for improved health outcomes (ACTUATE) |
| Amount | £704,276 (GBP) |
| Funding ID | EP/T015608/1 |
| Organisation | Engineering and Physical Sciences Research Council (EPSRC) |
| Sector | Public |
| Country | United Kingdom |
| Start | 09/2019 |
| End | 03/2021 |
| Description | Developing Community-Led Solutions to Antimicrobial Resistance: Building a One Health Approach in Low and Middle Income Countries |
| Amount | £133,107 (GBP) |
| Funding ID | EP/T02335X/1 |
| Organisation | Engineering and Physical Sciences Research Council (EPSRC) |
| Sector | Public |
| Country | United Kingdom |
| Start | 06/2020 |
| End | 05/2021 |
| Description | GCRF GIAA Growth Fund |
| Amount | £10,000 (GBP) |
| Organisation | Lancaster University |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 01/2019 |
| End | 03/2019 |
| Description | WASHable: Participatory design and community engagement Network on WASH in Lusophone and Francophone African Countries |
| Amount | £54,643 (GBP) |
| Funding ID | AH/T008482/1 |
| Organisation | Arts & Humanities Research Council (AHRC) |
| Sector | Public |
| Country | United Kingdom |
| Start | 02/2020 |
| End | 01/2022 |
| Title | Molecular and classical microbiology of dust in sub-Saharan domestic dwellings |
| Description | We have used molecular and classical microbiology to describe the bacterial diversity in dust from homes of differing economic status. In addition we have assess the antimicrobial resistance in cultured isolates. These methods are not innovative but the innovation lies within the design part of the project as the participants allowed baseline analysis of diversity to be carried out, they were then exposed to microbiological data and also involved in workshop regarding hygiene practices in the home and new ways of cleaning. This was then applied to the homes and the microbiology re-assessed. The novelty is combining microbiology with design in participatory workshops. |
| Type Of Material | Biological samples |
| Year Produced | 2019 |
| Provided To Others? | No |
| Impact | To be determined as the project progresses |
| Title | Bacterial DNA sequences from dust obtained from houses of differing economic status in Accra, Ghana |
| Description | 1.3M 215 bp sequences denoting identification to the level of genus from 12 houses comprising 4 replicates of 3 houses). This has been repeated: generating an additional 4M 215 bp sequences from pre- and post-interventions. We will now bale able to compare microbial diversity changes after interventions. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2020 |
| Provided To Others? | No |
| Impact | This will tell us the burden of pathogens in houses and whether interventions reduce their presence. |
| Description | Arts, AMR and Global Health: Getting Creative with Superbugs in Nepal |
| Organisation | HERD International |
| Country | Nepal |
| Sector | Private |
| PI Contribution | Participation by Tsekleves as a result of the award in a consortium event on A cross-discipline analysis of the Community Engagement for Antimicrobial Resistance Conference. The 3-day event was organised by the University of Leeds and HERD International aimed at investigating the scope of community engagement methods to tackle antimicrobial resistance. From an epidemiology and public health perspective, combining knowledge from multiple sources presents the best opportunity to adequately address public health concerns, such as in the case of AMR. The Arts and Humanities Research Council (AHRC) Dust Bunny project I lead demonstrates that the use of a design research approach (that allows us to understand complex human behaviour and turn that into actionable insights) to address antimicrobial resistance management at the household level can provide insights into behavioural challenges, which is key to changing behaviour that contributes to global health challenges. Using a design research approach is a practice that adds more value to the microbiology and public health aspects of the project, which would typically not engage further with households after sampling has been completed. As the design research community, along with other research communities, are called upon to tackle the complex global challenge of improving health and wellbeing, our research efforts should focus on co-producing with partners from the Global South strategies for promoting health and preventing illbeing of population. |
| Collaborator Contribution | The value of transdisciplinary research and in particular participatory design in this context was well echoed in the Community Engagement for Antimicrobial Resistance conference I participated in late June 2019. The insights gained from combining design and microbiology in the Dust Bunny project, as well as from the aforementioned event suggest that there are still challenges to address in enabling and supporting such transdisciplinary collaborations. Furthermore, there is still work to be done on enhancing other disciplines' understandings of the role and function of design in such specialist medical areas. There are, however, several opportunities arising in embedding design in health research, such as developing a better understanding of the health context and the individual, social and household drivers, and promoting best practices for public health implementation by engaging communities of citizens and professionals. |
| Impact | Collaborative bid to the GCRF Challenge Clusters entitled: Developing Community-Led Solutions to Antimicrobial Resistance: Building a One Health Approach in Low and Middle Income Countries. Awaiting results. |
| Start Year | 2019 |
| Description | Arts, AMR and Global Health: Getting Creative with Superbugs in Nepal |
| Organisation | University of Leeds |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Participation by Tsekleves as a result of the award in a consortium event on A cross-discipline analysis of the Community Engagement for Antimicrobial Resistance Conference. The 3-day event was organised by the University of Leeds and HERD International aimed at investigating the scope of community engagement methods to tackle antimicrobial resistance. From an epidemiology and public health perspective, combining knowledge from multiple sources presents the best opportunity to adequately address public health concerns, such as in the case of AMR. The Arts and Humanities Research Council (AHRC) Dust Bunny project I lead demonstrates that the use of a design research approach (that allows us to understand complex human behaviour and turn that into actionable insights) to address antimicrobial resistance management at the household level can provide insights into behavioural challenges, which is key to changing behaviour that contributes to global health challenges. Using a design research approach is a practice that adds more value to the microbiology and public health aspects of the project, which would typically not engage further with households after sampling has been completed. As the design research community, along with other research communities, are called upon to tackle the complex global challenge of improving health and wellbeing, our research efforts should focus on co-producing with partners from the Global South strategies for promoting health and preventing illbeing of population. |
| Collaborator Contribution | The value of transdisciplinary research and in particular participatory design in this context was well echoed in the Community Engagement for Antimicrobial Resistance conference I participated in late June 2019. The insights gained from combining design and microbiology in the Dust Bunny project, as well as from the aforementioned event suggest that there are still challenges to address in enabling and supporting such transdisciplinary collaborations. Furthermore, there is still work to be done on enhancing other disciplines' understandings of the role and function of design in such specialist medical areas. There are, however, several opportunities arising in embedding design in health research, such as developing a better understanding of the health context and the individual, social and household drivers, and promoting best practices for public health implementation by engaging communities of citizens and professionals. |
| Impact | Collaborative bid to the GCRF Challenge Clusters entitled: Developing Community-Led Solutions to Antimicrobial Resistance: Building a One Health Approach in Low and Middle Income Countries. Awaiting results. |
| Start Year | 2019 |
| Description | Noguchi Memorial institute for Medical Research, University of Ghana, Accra, Ghana |
| Organisation | Noguchi Memorial Institute for Medical Research (NMRR) |
| Country | Ghana |
| Sector | Academic/University |
| PI Contribution | Project partner. |
| Collaborator Contribution | Design and implementation of project |
| Impact | papers in preparation. Impact studies |
| Start Year | 2018 |
| Description | Women's Economic Imperative 1st conference in Edinburgh, Scotland |
| Organisation | Women's Economic Imperative |
| Sector | Charity/Non Profit |
| PI Contribution | Tsekleves was invited to participate in the Women's Economic Imperative 1st conference in Edinburgh, Scotland (www.weiforward.org/conference/). The conference focused on the economic empowerment of women and the importance of health in this, especially in a Global South context. The Sustainable Development Goals (SDGs) framework serve as the organizing frame for the current global development agenda. Specific goals such as Goal 3 - Good Health and Wellbeing Goal 5 - Gender Equity, Goal 8 - Decent Work and Economic Growth, and Goal 10 - Reduced Inequalities - serve as action points for focusing on the health of women in sub-Saharan Africa as an economic value for the robust development of communities, municipalities, and cities. In many developing countries, including many in Africa, health services and care are not always available to everyone who needs it. I was invited to make a contribution by presenting the role of health in gender and participate in a workshop for the design of an online dashboard for the health and economic empowerment of women, which will be launched within 2020. |
| Collaborator Contribution | It is essential that we focus on interventions at the level of social and health policy, the community, and systems of health care delivery and female representation in the health care professions, research and policy making. In many African countries, even the most basic health care is unavailable to the majority of women and children. Investments must target the inequities that prevent access to care, for example, by removing financial barriers and providing social health protection. Unless that happens, the SDG targets will not be reached. Furthermore, the partners and networks developed in the conference are now participating as external advisors in new research project where the role of gender is a critical component. |
| Impact | Members from the WEI consortium participate in the external advisory committee of GCRF related project that I hold, advising on gender and women empowerment. |
| Start Year | 2019 |
| Title | Educational and Information leaflet intervention on best cleaning practices |
| Description | A new cleaning education and information intervention leaflet has been produced by the project team. This integrates insights from the project findings and has been iteratively design with the communities. An intervention, a new regime of cleaning practices agreed through the codesign workshop and practiced for thirty days, was made in (n=7) households and another round of microbiological sampling (n=12) and analysis conducted to ascertain any impact on the domestic microbiome. A post-intervention interview was also conducted by going back to the households who participated in the co-design workshop. This coincided with the second round of microbiological sampling. |
| Type | Preventative Intervention - Behavioural risk modification |
| Current Stage Of Development | Refinement. Non-clinical |
| Year Development Stage Completed | 2021 |
| Development Status | Under active development/distribution |
| Impact | We sought to find out from participants, who took part in the observational study and participated in the co-design workshop, whether the personalised interventions developed influenced their cleaning practices. We discovered that they were influenced by the project in one way or the other as represented in the narratives below. More precisely, we documented new cleaning practices adopted. Most of these practices refer to a) a more structured approach to cleaning in the home; b) increasing the cleaning frequency; c) use of cleaning detergents; and d) use of different cleaning material for different surfaces and rooms. "The project, especially the workshop has influenced my cleaning. At first, we clean the sink before cleaning the bath but now, we clean the bath, then the sink and also wash and dry the brush before use again" (Female, High income community). "The project has influenced me [] I used to clean ones a week, now I do it twice or sometimes three times in a week "(Female, Lower income/working class community). "I learnt so much from the project to improve on my cleaning. At first, I used only washing powder but now I use detergent to wash and clean. I now use different brash and bucket to clean the toilet area put detergent into the closet after use to protect the next user infection" (Female, Middle income community). " [] before the project, I used to mop using the same mop for all the rooms (living, sleeping, kitchen, toilet and porch) but I realized from the project that it is not a good way of cleaning" (Female, Low income/poor community). |
| URL | https://dustbunnyglobal.wordpress.com/2021/05/01/educational-and-information-leaflet-on-best-cleanin... |
| Description | Co-design of home cleaning Interventions in Accra, Ghana |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Study participants or study members |
| Results and Impact | In September 2019 the Dust Bunny team run a co-design workshop with several of the households participating in the project. The aim of the workshop was to co-design interventions that householders will take back and implement. The households were representative of the 4 socio-economic groups found in Ghana. The one-day workshop included several creative activities and tools which were designed to elicit response and engagement from participants. Some of the tools and activities placed participants in mock-up versions of different types of households and presented in visual ways the bacteria found in households form the microbiological analysis and their potential impact to health.They then explored the different cleaning hotspots where they believed bacteria are found in their homes and developed cleaning agreements that each household would take back home and test for a month.Participants were deeply engaged with the data, especially the findings from the microbiological analysis of dust. They wanted to know the number of different bacteria found and from which socioeconomic groups. |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://dustbunny.global/2019/10/22/dust-bunny-households-co-design-home-cleaning-interventions/ |
| Description | Community Engagement and sharing of Leaning Education & Information leaflet |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | As part of the Dust Bunny project commitments, series of community dissemination meeting were organized to share some key findings with the people and district health and education authorities. From April to May 2021 over 150 participants were engaged in four meetings organised across the different regions in Accra where our communities reside. Participants included representatives from the district health directorate and the health facilities in each of the study communities, representatives from the Ghana education service, the chiefs and opinion leaders, Assembly members, selected study participants and few community members. Four short presentations were made to guide discussions. The first presentation focused on the global burden of AMR and why it is very important to tackle it from all possible angles including the home. The second was on selected key findings from the study and the cleaning intervention implemented, the fourth presentation was testimonies given by participants who took part in the cleaning intervention, and the fourth was on the cleaning education and information material. Each presentation was followed by a discussion session, where questions were asked, and answers provided. There were also general discussions with people making suggestions on the usefulness of the project, especially the interventions implemented. Generally, participants in all the communities were happy about the study and have requested for its expansion for the benefit of all residents. The following key discussion points and issues were raised: The cleaning education and information material was very well received, and the people wanted more to be distributed in the communities. All the district directors of health service have requested for the soft copies of the material for their own printing and distributions. It was the toast of all participants! Chiefs in all the communities have requested that, if covid-19 pandemic is over, they will be ready to organise community durbars for us to share the findings, especially the cleaning education and information materials and the finding that bacteria were found in the homes, including bedrooms. The chiefs and Assembly members pledged their supports for any research project that will be brought into their communities because, they found the Dust bunny project to be very useful on that could promote the health of community members. The people want to know how to curb dust from entering their rooms, since they have no control over it. In Abokobi where road construction was ongoing, the dust situation was very unbearable. Participants in Adenta requested that the cleaning intervention is implemented in more homes, if not all the homes in the municipality. Participants in Madina said it will be good to test the dust from the market to know the infection there too. They concluded that, they believe that the situation will be worst in the market compared to the home. Some people wanted to know how participants were selected for the cleaning intervention because they would have loved to participate in it. It came to light that the cleaning intervention should also be implemented in schools to teach the children how to clean properly. |
| Year(s) Of Engagement Activity | 2021 |
| URL | https://dustbunnyglobal.wordpress.com/ |
| Description | Community and experts pave the way for new Global Health project |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Study participants or study members |
| Results and Impact | In a co-design workshop run in February in Accra, representatives of the communities participating in the Dust Bunny project and experts (public health, epidemiology, behavioural psychology, etc) came together to co-develop an interdisciplinary research project addressing infectious disease in the home environment in Ghana. Through a series of creative and interactive activities, workshop co-designers identified the key health challenges faced by communities as well as the barriers to conducting research with communities in Ghana. These included the role of cleaning and hygiene practices in the transmission of infectious disease in the home and the impact of cultural and religious beliefs on them. Furthermore, attention was paid to antimicrobial resistance (AMR) in Ghana in light of the national action plan on AMR. In terms of the challenges of conducting research with local communities, these included access to communities and establishing trust, use of technology for recording data (i.e. cameras, audio recorders) and sampling of microbiological material, such as dust. Again the role of culture and religion featured on these discussions. Workshop participants, led by community members provided ways of mitigating these challenges and set aims and objective fo a new and impactful project that would tackle these. Examples included working with schools (primary and junior), religious groups (churches, mosques) and other social groups. This led to discussion and a set of research methods that would work well with the identified communities, including citizen science and research endorsed, carried and promoted by different communities. Following this and working in groups, workshop participants were invited to think and discuss about what they would hope to learn knowledge from project such as this, what is important about that knowledge, how might it impact Ghana and the world. This led to the identification of several research outcomes as well as pathway to impact for the project. What became clear from this co-design workshop was the value of engaging the community along with experts in the research planning process and in defining the wider contexts of infectious diseases , as well as the research methods, outcomes, stakeholders and pathways to impact. |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://dustbunny.global/2019/02/26/community-and-experts-pave-the-way-for-new-global-health-project... |
| Description | Dust Bunny National Stakeholder Workshop |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | The workshop was a face-to-face meeting involving 30 stakeholders from different disciplinary backgrounds explored AMR within the context of Ghana. Following a presentation of the project and its findings, participants engaged in activities that facilitated discussions and identification of local AMR challenges and how Community Engagement could help address this, as well as the next steps for the project. |
| Year(s) Of Engagement Activity | 2020 |
| Description | Engage community and experts to develop directions for a new Global Health project |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | In a co-design workshop run in February in Accra, representatives of the communities participating in the Dust Bunny project and experts (public health, epidemiology, behavioural psychology, etc) came together to co-develop an interdisciplinary research project addressing infectious disease in the home environment in Ghana. Through a series of creative and interactive activities, workshop co-designers identified the key health challenges faced by communities as well as the barriers to conducting research with communities in Ghana. These included the role of cleaning and hygiene practices in the transmission of infectious disease in the home and the impact of cultural and religious beliefs on them. Furthermore, attention was paid to antimicrobial resistance (AMR) in Ghana in light of the national action plan on AMR. Workshop participants, led by community members provided ways of mitigating these challenges and set aims and objective fo a new and impactful project that would tackle these. Examples included working with schools (primary and junior), religious groups (churches, mosques) and other social groups. This led to discussion and a set of research methods that would work well with the identified communities, including citizen science and research endorsed, carried and promoted by different communities. Following this and working in groups, workshop participants were invited to think and discuss about what they would hope to learn knowledge from project such as this, what is important about that knowledge, how might it impact Ghana and the world. This led to the identification of several research outcomes as well as pathway to impact for the project. What became clear from this co-design workshop was the value of engaging the community along with experts in the research planning process and in defining the wider contexts of infectious diseases , as well as the research methods, outcomes, stakeholders and pathways to impact. |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://dustbunny.global/2019/02/26/community-and-experts-pave-the-way-for-new-global-health-project... |
| Description | Engagements with Ghana Broadcasting TV for developing a video documentary about the project |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Initial interaction and interview of team members by Ghan Broadcasting (TV) with the aim of producing a documentary about the project and research conducted by the team in Ghana. |
| Year(s) Of Engagement Activity | 2019 |
| Description | Engaging with community and experts in Accra |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | The Dust Bunny team run engagement workshops in the second week of February in Accra, Ghana. The workshops engaged with members of the community who are participating in the project as well as Ghanian external to the project public health experts and researchers. It presented the preliminary findings (from the design ethnography and first round of microbiology analysis) and provided a space for feedback and debate. It also presented some of the challenges faced by the research team in conducting design-led research in Ghana and invited workshop participate in brainstorming sessions aimed at generating solutions . Themes that emerged from the workshop related to the influence of cultural, religious practices and beliefs of different communities in the cleaning and hygiene practices employed across a range of households. Furthermore, there was discussion around the importance of establishing trust and rapport with household research participant prior to the fieldwork, especially given the morally bound nature of the research. In addition to this, the tables were turned with workshop participants asking questions to the research team and making suggestions for maximising the dissemination of findings. Lastly, community members and experts alike were provided with dissemination material to take back to their respective communities. |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://dustbunny.global/2019/02/19/engaging-with-community-and-experts-in-accra/ |
| Description | Engaging with community and experts in Accra |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Study participants or study members |
| Results and Impact | The Dust Bunny team run engagement workshops in the second week of February in Accra, Ghana. The workshops engaged with members of the community who are participating in the project as well as Ghanian external to the project public health experts and researchers. It presented the preliminary findings (from the design ethnography and first round of microbiology analysis) and provided a space for feedback and debate. It also presented some of the challenges faced by the research team in conducting design-led research in Ghana and invited workshop participate in brainstorming sessions aimed at generating solutions . Themes that emerged from the workshop related to the influence of cultural, religious practices and beliefs of different communities in the cleaning and hygiene practices employed across a range of households. Furthermore, there was discussion around the importance of establishing trust and rapport with household research participant prior to the fieldwork, especially given the morally bound nature of the research. In addition to this, the tables were turned with workshop participants asking questions to the research team and making suggestions for maximising the dissemination of findings. Lastly, community members and experts alike were provided with dissemination material to take back to their respective communities. |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://dustbunny.global/2019/02/19/engaging-with-community-and-experts-in-accra/ |
| Description | Impact refocusing during the International Forum on Health and Wellbeing |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Lancaster University in collaboration with Lancaster University Ghana and with funding from the UKRI and the Global Challenges Research Fund, has organised the International Forum on Health and Wellbeing, with the main objective of creating impact on existing research among academics in the areas of social health, medicine, environment, sustainability, water and food availability. The Forum took place in the Lancaster University Ghana between the 21-22 March 2019. Following the Forum the Dust Bunny team explored how to achieve maximum impact and genuine, embedded change for the better across Ghana and wider Africa. The project team along with several experts from Ghana and Africa discussed how the outputs of the project research can be applied, disseminated, adapted and further developed in order to achieve maximum benefit in African countries. The team also discussed some of barriers to change in this area as well as some of the opportunities that might arise from combining the results of multiple, related work to tackle key issues. Lastly everyone engaged in a discussion on local, national and continental issues in the area of health and wellbeing more broadly and how research can be applied in the right way to meet these challenges in the most effective way. Apart from achieving wider dissemination of the Dust Bunny through the Forum, This also led to new collaborations and the development of a revised Impact strategy and pathway for the Dust Bunny project. |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://dustbunny.global/2019/03/27/dust-bunny-maximises-impact-during-the-international-forum-on-he... |
| Description | News Article on Conversation Africa |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | Article entitle "New ways to clean homes may help in Ghana's fight against bacterial disease" was published on the 11th of February 2020 in Conversation Africa, reaching several thousands readers. The article was also feature by other media outlets: Ghana: New Ways to Clean Homes May Help in Ghana''s Fight Against Bacterial Disease https://allafrica.com/stories/202002120173.html Reach: 59840 New ways to clean homes may help in Ghana''s fight against bacterial disease Modern Ghana (Web), 11/02/2020, Unattributed https://www.modernghana.com/news/984085/new-ways-to-clean-homes-may-help-in-ghanas-fight-against-ba.htmlKeyword : Lancaster University Reach: 2014 Play Video Modern Ghana (Web), 11/02/2020, Unattributed analysing the findings from these.The key message is that citizens can do as much as scientists to fight drug-resistant bacteria and keep homes healthy.Emmanuel Tsekleves is an Associate Professor at Lancaster University. He has received funding from the https://www.modernghana.com/news/984085/new-ways-to-clean-homes-may-help-in-ghanas-fight.html Reach: 2014 New ways to clean homes may help in Ghana''s fight against bacterial disease Citifmonline (Web), 11/02/2020, Unattributed https://citinewsroom.com/2020/02/new-ways-to-clean-homes-may-help-in-ghanas-fight-against-bacterial-disease/ Reach: 8367 |
| Year(s) Of Engagement Activity | 2020 |
| URL | https://theconversation.com/new-ways-to-clean-homes-may-help-in-ghanas-fight-against-bacterial-disea... |
| Description | Video documentary of project activities on Ghana TV |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Following the popularity of the first video of the project on Ghana TV in June/July 2019, a new video documentary has been created about the Dust Bunny project by the journalist Peggy Ama Donkor (Journalist of the Year 2005 award). The new video documentary features the co-design workshop held by the Dust Bunny researchers in Accra, on September 2019. It also includes interviews from the research team and workshop participants. The video was aired on Ghana Today Television (the national public broadcaster of Ghana, run by the Ghana Broadcasting Corporation) in in October and November 2019 for more than 15 times and was seen by several thousands of viewers. It is also available to view on Facebook , where it was posted on the 31st of January 2020. |
| Year(s) Of Engagement Activity | 2019,2020 |
| URL | https://m.facebook.com/story.php?story_fbid=10157306901006678&id=725321677&sfnsn=mo |